OBJECTIVES: Recently, the American Diabetes Association (ADA) redefined the criteria of prediabetes, which has lowered the diagnostic level of fasting plasma glucose (FPG) from 110 to 125 mg/dl, down to levels between 100 to 125mg/dl. The purpose of this study was to determine the predictive cutoff level of FPG as a risk for the development of diabetes mellitus in Korean men. METHODS: A retrospective cohort study was conducted on 11, 423 (64.5%) out of 17, 696 males < or =30 years of age, and who met the FPG of < or =125 mg/dl and hemoglobin A1c of < or = 6.4% criteria, without a history of diabetes, and who were enrolled at the screening center of a certain university hospital between January and December 1999. The subjects were followed from January 1999 to December 2002 (mean follow-up duration; 2.3 (+/-0.7) years). They were classified as normal (FPG < 100mg/dl), high glucose (FPG > or =100mg/dl and < 110mg/dl) and impaired fasting glucose (FPG > or =110mg/dl and < or =125mg/dl) on the basis of their fasting plasma glucose level measured in 1999. We compared the incidence of diabetes between the 3 groups by performing Cox proportional hazards model and used receiver operating characteristic analyses of the FPG level, in order to estimate the optimal cut-off values as predictors of incident diabetes. RESULTS: At the baseline, most of the study subjects were in age in their 30s to 40s (mean age, 41.8 (+/-7.1) year). The incidence of diabetes mellitus in this study was 1.19 per 1, 000 person-years (95% CI=0.68-1.79), which was much lower than the results of a community-based study that was 5.01 per 1, 000 person-years. The relative risks of incident diabetes in the high glucose and impaired fasting glucose groups, compared with the normal glucose group, were 10.3 (95% CI=2.58-41.2) and 95.2 (95% CI= 29.3-309.1), respectively. After adjustment for age, body mass index, and log triglyceride, a FPG greater than 100mg/dl remained significant predictors of incident diabetes. Using the receiver operating characteristic (ROC) curve, the optimal cutoff level of FPG as a predictor of incident diabetes was 97.5 mg/dl, with a sensitivity and a specificity of 81.0% and 86.0%, respectively. CONCLUSION: These results suggest that lowering the criteria of impaired fasting glucose is needed in Korean male adults. Future studies on community-based populations, including women, will be required to determine the optimal cutoff level of FPG as a predictor of incident diabetes.